February World Medical Journal Review
Mark C. Glaum, M.D., Ph.D., WAO Guest Editor, Assistant Professor of Medicine and Pediatrics, University of South Florida College of Medicine, reviewed premier February medical journal articles for practicing allergists. Read his top 3 picks below and for the other 7 reviews, click here.
1. SALMETEROL MULTICENTER ASTHMA RESEARCH TRIAL (SMART)
To compare the safety of adding salmeterol or placebo to "usual" asthma care, subjects (> 12 years old n=26,355) with physician-diagnosed asthma were randomized to receive salmeterol, 42 mcg twice daily via MDI or placebo MDI over 28 weeks in a double-blind observational study. Telephone follow-up was scheduled monthly. The study was terminated prior to completion due to safety findings. In the salmeterol group, there were small but statistically significant increases in respiratory-related deaths (24 vs 11; relative risk [RR]=2.16; 95% confidence interval [CI], 1.06-4.41) and asthma-related deaths (13 vs 3; RR, 4.37; 95% CI, 1.25-15.34) and in combined asthma-related deaths or life-threatening experiences (37 vs 22; RR, 1.71; 95% CI, 1.01 to 2.89). Differences occurred largely in African-American subpopulations. The study was not designed to control for adherence to other asthma medications, and follow-up was conducted only by phone interview every four weeks. Editor's comment: Studies specifically designed to assess safety of long-acting beta 2 agonists (LABA) in combination with inhaled corticosteroids are needed to stratify the potential risk of using LABA in subpopulations of asthmatic patients.
Nelson HS, Weiss, ST, Bleeker ER, et al. Chest 2006; 129:15-26
2.) OMALIZUMAB PROTECTIVE FOR RUSH IMMUNOTHERAPY
Adults (mean age 33, n=159) with ragweed allergic rhinitis were enrolled in a randomized double-blind placebo-controlled study to receive 9 weeks of omalizumab (0.016 mg/kg/IgE/month) or placebo followed by one-day rush immunotherapy (RIT) with Amb a 1 (1.2-4 µg). After maintenance dose was achieved, omalizumab or placebo was continued for an additional 12 weeks along with maintenance immunotherapy. As expected, levels of ragweed-specific IgG increased with immunotherapy (>11 fold), while free IgE levels decreased in omalizumab-treated patients (>10 fold). Subjects receiving omalizumab experienced fewer adverse reactions (33%) during RIT than those receiving placebo (55%), and post-hoc blind analysis suggested an even greater reduction in serious adverse events (symptoms in >1 organ system) in the omalizumab group vs placebo (5.6% vs 25.6%) following RIT. Once maintenance was achieved, subjects receiving omalizumab plus immunotherapy also reported fewer symptoms in the ragweed season as compared to placebo. Editor's comment: Omalizumab may protect against systemic reactions from immunotherapy in allergic rhinitis patients.
Casale TB, Busse WW, Kline LN, et al. J Allergy Clin Immunol 2006; 117:134-40
3.) ROLE OF TUMOR NECROSIS FACTOR ALPHA IN REFRACTORY ASTHMA
Subjects with refractory (severe persistent) asthma, mild to moderate asthma and non-asthmatic controls underwent peripheral blood draw to assess for TNF-alpha activity on mononuclear cells. Compared to non-asthmatic controls and mild to moderate asthmatics, subjects with severe persistent asthma demonstrated increased expression of membrane-bound TNF-alpha, TNF-alpha receptor 1, and TNF-alpha converting enzyme on peripheral blood mononuclear cells. Ten subjects (ages 25-59 years) with refractory asthma were then enrolled in a randomized, double-blind, placebo-controlled, crossover study to determine if TNF-alpha blockade would improve methacholine sensitivity, asthma quality of life scores and post-bronchodilator FEV1. Following ten weeks of treatment with the TNF-alpha receptor antagonist, etanercept, subjects in the treatment group were less sensitive to methacholine provocation and showed improvement in asthma quality of life scores and in post-bronchodilator FEV1. Editor's comment: This pilot study suggests that TNF blockade may improve symptoms and pulmonary function of severe asthmatics. Larger clinical trials are warranted to validate this association. Please note excellent accompanying editorial.
Berry MA, Hargadon B Shelley M, et al. N Engl J Med 2006;354;7: 697-708, Erzurum SC;354;7: 754-58
To read the additional reviews, click here.
WAO Member Society Spotlight – 2006 AAAAI Annual Meeting: the Scientific Basis of Allergy Practice
With more than 400 educational sessions at the AAAAI Annual Meeting, March 3-7, in Miami Beach, Florida, delegates learned about the latest developments in the specialty and how that cutting-edge research applies to patient care.
Key sessions included:
High profile speakers addressed issues with a global impact during the two Keynote Sessions. Clinical Trials and the Public Trust was presented by Jeffrey M. Drazen, MD, editor of The New England Journal of Medicine, and Human Disease: A Sum Game of the Gene and the Environment was presented David A. Schwartz, MD, MPH, director of the National Institute of Environmental Health Sciences.
The Plenary Sessions were the premiere scientific sessions of the Annual Meeting. Sessions included Seeing is Believing: Host and Hostility, Anaphylaxis: Bridging the Gap from Basic Science to Clinical Practice (Presidential Plenary), The Science of Evidence-Based Medicine in Asthma, and Allergic/Immunologic Diseases: Dissection and Modulation.
Science & Surf: Featured Poster Session & Reception
Delegates had the opportunity to learn, network and enjoy tropical breezes during the Science & Surf: Featured Poster Session & Reception. Delegates learned about science of high significance in the field and earned CME/CE when they visited the featured poster session.
Anaphylaxis Day activities
From the Presidential Plenary Session and special seminars, to intubation simulations and new Anaphylaxis Education Tool Kits, Anaphylaxis Day emphasized the importance of the role of the allergy/immunology specialist in anaphylaxis management and prevention.
Bring Your Own Patient Sessions
New workshops offered delegates the opportunity to submit difficult patient cases from their practices for discussion by leading experts in the field. Topics included Patients with Difficult to Treat Urticaria, Patients with Recurrent Infection but Normal Screening, Patients with Difficult to Treat Asthma and Patients with Difficult to Treat Food Allergies.
Member Service Programs
These new programs addressed critical information for the successful practice of allergy/immunology. Topics included Maintenance of Certification (American Board of Allergy and Immunology), Regulatory Issues Affecting the Specialty (Food and Drug Administration), and Legislative Issues Affecting the Specialty (Joint Council of Allergy, Asthma and Immunology).
Michael A. Kaliner, MD, FAAAAI, received the AAAAI Distinguished Clinician Award. WAO's president has published more than 475 articles, reviews, and books relating to allergies, sinusitis and asthma. He has served as editor, or on the editorial boards, of many allergy and asthma journals, including The Journal of Allergy and Clinical Immunology (JACI), eMedicine Journal, and Allergy & Clinical Immunology International - Journal of the World Allergy Organization (ACII-JWAO).
Visit the AAAAI's Annual Meeting Web site, www.annualmeeting.aaaai.org for important post-meeting resources, including CME/CE certificates, session handouts, Annual Meeting news and a collection of photos from the 2006 Annual Meeting.
WAO Now: What's New in the World of WAO
WAO Short-Term Research Fellowship Program
Applicants are reminded that the deadline for applications for the WAO Short-Term Research Fellowship program is March 31, 2006. For further details, click here.
World Allergy Forum Held at AAAAI Annual Meeting
"Sublingual Immunotherapy - Is There a Role?"
Our superb international faculty, chaired by Michael A. Kaliner, provided a worldwide update on sublingual immunotherapy. The first speaker, G. Walter Canonica (Genova, Italy), presented an analysis of long-term efficacy and safety of sublingual immunotherapy. The presentation by Anthony J. Frew (Brighton, United Kingdom) focused on the mechanisms of sublingual immunotherapy and how it differs from injection immunotherapy. The symposium was concluded by Linda Cox (Fort Lauderdale, FL, U.S.), who discussed whether the United States is ready for sublingual immunotherapy.
Click here to view abstracts and presentation slides
Sign up for On-Line Journal Subscription
WAO and Hogrefe & Huber Publishers are offering a limited number of free on-line subscriptions to Allergy & Clinical Immunology International - Journal of the World Allergy Organization for members in developing countries. If you are interested in receiving a complimentary, on-line subscription, please send an e-mail to firstname.lastname@example.org, noting "Free Journal Subscription" in the subject line, with the following details:
City, State/Province and postal code
Name of Member Society
And In Other News
Allergy Book Review
Bernard A. Cohen
Elsevier Mosby, Third Edition, 2005
List Price: $219.00 USD
Available from: http://us.elsevierhealth.com/product.jsp?isbn=1416024689
Reviewer: Dr. Preeti Joshi
Staff Specialist, The Children's Hospital at Westmead, NSW, Australia
This beautifully illustrated textbook provides a clear and comprehensive coverage of dermatological problems in children. It is well-organized and indexed in a problem-orientated fashion, making it easy-to-access information at the bedside.
The book is addressed to all clinicians and, for clinical immunologists, the chapters devoted to disorders of the hair, nails and oral cavity will prove particularly useful. Medical students too, will find that the book covers many common conditions and explains their salient features.
While the text is succinct and easy to read, the outstanding feature of the book is the photography. This is indeed a very impressive collection of photographs, particularly for a single author. There are approximately four large, well-lit color plates on each page, often with multiple photos to illustrate different features of the disease. The text itself is supplemented by helpful algorithms for identifying the aetiology of common presenting problems such as neonatal rashes. For those requiring more detail, there is an up-to-date further reading list at the end of each chapter.
In summary this is a pleasing book with exceptional photographs. It is an excellent resource for reference but is also pleasant enough to read from cover to cover. Any clinician who treats children will find this a useful addition to their library.
Find more allergy book reviews on the WAO Website here.